| NPI | 1053473090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C174846) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00047232) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2022-12-13 |